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Table 2 Documented systems changes

From: Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals

Baseline (2012) Current (2016)
Centralised specialist clinics in tertiary hospital
Poor communication between services (with opportunities to improve use of telemedicine)
- Systemic integration of telemedicine into health services
- Regular case conferencing with remote clinics through telehealth
- Clinical Register reports circulated quarterly with information around prevalence of DIP across regions
- Improved referral pathways
- Enhanced awareness by PHC clinicians of availability of hospital-based specialists for phone advice and case conferences
Limited engagement of diabetes and allied health specialists in remote settings and limited access to these specialist services close to home for remote women - Regular outreach visits and telehealth by specialists (including dieticians)
- Increased capacity of Primary Health Care clinicians to manage DIP in remote communities with support by phone/telehealth from hospital-specialists (hub and spoke model)
Minimal DIP educational activities for Health Professionals
Limited self-management educational resources available for women
Limited access to glucose monitors
- Regular DIP educational forums for Health Professionals (including a focus on preconception care and postpartum care)
- DIP educational resource for women
- Free access to glucose monitors
Coordination and Transition of Care
Remote clients required to travel to access specialist care - Specialist clinic times changed to better meet the needs of remote clients
- Electronic care plans used in primary health care.
- Multi-disciplinary collaboration at outreach meetings to coordinate care provided to complex cases
Clinical Guidelines
Use of a standard treatment manual, based on the Australian Diabetes in Pregnancy Society guidelines
Different guidelines used in Primary Health Care and hospital and in different regions within the NT
-Adoption of International Association of Diabetes in Pregnancy Study Groups and World Health Organisation guidelines (which have a lower threshold for diagnosis and earlier screening)
-Guidelines were aligned between Primary Health Care and hospital to be consistent between guidelines and across all NT regions
-Strong promotion of guidelines in education sessions